The thyroid gland is a butterfly-shaped endocrine gland located in the lower front of the neck, just below the voice box. It makes thyroid hormones that secrete into the blood and travel to every tissue in the body. The thyroid gland regulates the body’s metabolism, keeping the organs functioning and helping the body conserve heat.
Sometimes the thyroid produces too much hormone or develops structural problems like swelling and nodule/cyst growths. When these issues occur, thyroid surgery may be necessary.
Thyroid operations are recommended for patients who have a variety of thyroid conditions: cancerous and benign thyroid nodules, large thyroid glands (goiters), and overactive thyroid glands.
Facts of Thyroid Surgery
The different thyroid operations a surgeon may perform are as follows:
- Excisional biopsy: removing a small part of the thyroid gland (rarely done today).
- Lobectomy: removing half of the thyroid gland (the most frequent way to remove a nodule).
- Total thyroidectomy: removing all identifiable thyroid tissue
The most usual reason for surgery is to remove a thyroid nodule that has been found to be suspicious through an aspiration biopsy. The following biopsy results will lead to a possible recommendation for surgery.
- Cancer (papillary)
- Inconclusive biopsy
- Molecular marker testing of a biopsy specimen which indicates a risk of malignancy
- Possible cancer (follicular neoplasm or atypical findings)
Sometimes surgery is recommended for nodules that have benign biopsy results if the nodule is large, continues to increase in size, or is causing pain or difficulty swallowing. Hyperthyroidism (Grave’s disease), large and multinodular goiters, and any goiters that may be causing symptoms can be alleviated with surgery.
Surgery is most urgently needed when nodules suspicious for thyroid cancer are present. In the absence of a possibility of thyroid cancer, there may be nonsurgical options of therapy depending on your diagnosis. Discuss other options for treatment with a physician with expertise in thyroid diseases.
Pre-Op Steps for Thyroid Surgery
Before the surgery is recommended, a thorough examination is needed. Your doctor will review your medical history and perform a physical exam that includes a heart evaluation. Electrocardiograms and chest x rays are required for patients over that are over 45 years old or have symptoms of cardiac disease. Blood tests are sometimes performed to determine if a bleeding disorder is present.
Patients who are experiencing a change in voice, or who have gone through a previous neck operation (thyroid surgery, parathyroid, spine, carotid artery surgery), or patients who have suspected thyroid disease should have their vocal cord function evaluated before the operation. These evaluations are necessary to determine whether the recurrent laryngeal nerve that controls the vocal cord muscles is working regularly. If medullary thyroid cancer is suspected, patients should be assessed for coexisting adrenal tumors, hypercalcemia, and hyperparathyroidism.
After a pre-op evaluation as well as a meeting with the anesthesiologist, you will be ready for surgery. You should eat or drink nothing after midnight the day before surgery and leave valuables and jewelry at home. The surgery takes 2-3 hours after which you will slowly wake up in the recovery room. Thyroid surgery is best performed by a surgeon who has undergone specialized training and performs thyroid surgery on a regular basis. Ask your physician where they would go to get a thyroid operation or where they would send a family member.
Depending on your condition, the surgeon will remove half, nearly all, or all of your thyroid. The surgeon should explain whether the thyroid operation would be a lobectomy or total thyroidectomy and the reasons why the procedure is recommended.
Patients with papillary or follicular thyroid cancer, graves’ disease (hyperthyroidism), many surgeons recommend total or near total thyroidectomy.A lobectomy may be recommended for overactive one sided nodules or nodules that are causing symptoms of compression, hoarseness, shortness of breath, or difficulty swallowing.
The risks of a thyroid operation involve possible damage to important structures near the thyroid like the parathyroid glands which manage calcium levels and damage to recurrent and external laryngeal nerves which control the vocal cords. Complications due to the risks of surgery occur in about 2% of cases. These risks and complications include bleeding that can cause respiratory distress, injury to the laryngeal nerve which can cause permanent hoarseness and breathing problems, and damage to the parathyroid glands that control calcium levels in the body. This leads to hypoparathyroidism and hypocalcemia.
These complications occur mostly in patients with invasive tumors, extensive lymph node involvement, patients requiring a second thyroid surgery, and patients with large goiters that go below the collarbone.
Depending on how much of the thyroid gland is removed, and whether the patient is already on thyroid medication for low thyroid (Hashimoto’s thyroiditis), a thyroid pill may be required after semi thyroidectomy surgery. Total thyroidectomy leaves the patient with no internal source of thyroid hormone, and they will need a lifelong thyroid hormone replacement.
Minimally invasive video-assisted thyroidectomies are performed through a small incision with the aid of a video camera. More invasive thyroidectomies are conducted through a standard incision in the neck. There may be a surgical drain in the incision in your neck which is removed after the surgery. Your throat may be sore afterward because of the breathing tube placed during the operation. Once you are fully awake you will be moved to a hospital bed and be able to eat and drink as you wish. Most patients are kept in the hospital for about 24 hours and released on the morning following the operation.
Post-Op Step for Thyroid Surgery
Limit your extreme physical activity after surgery. This will reduce the risk of post operative neck hematoma (blood clot) and breaking of stitches in the wound closure. Delay activities like vigorous sports, swimming, and activities that include heavy lifting for at least ten days. Normal activity can begin on the first post-operative day.
Life after surgery will not be markedly different; you will be able to do anything you could do before surgery unless you become hypothyroid following surgery, which would require treatment with a thyroid hormone. This is especially likely if you have had your whole thyroid gland removed.
Make sure you understand the reasons for your operation, alternative treatments, potential risks and benefits of the operation.
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